Advancing a Healthier Wisconsin · The WIN Initiative · FHG-internal
WIN is Advancing a Healthier Wisconsin's cardiovascular initiative — bringing high blood pressure under control across four Wisconsin health systems. Two questions decide whether it becomes the way the state cares for its people: can we prove it works, and can we grow it to the counties that need it most.
The mandate
Advancing a Healthier Wisconsin
Funds WIN and carries the mandate to reach all 72 counties across three pillars. It needs to know its investment is working.
The study
WIN clinical team
MCW cardiology sets the protocol, the endpoints, and the criteria for control.
The economics
The health plans
Molina, Chorus, and their peers are where the sustaining dollars come from — the buyers who pay for prevention once it is proven.
The measurement
Forward Health Group
Builds the comparison group and the measurement that turn the work into evidence AHW and the plans can hold.
The Goal
The reason the study exists.
AHW funds WIN to make Wisconsin healthier. The question every funder reaches is whether the dollars are doing anything — and WIN is built to answer it with evidence, not a report: a designed study, a real comparison group, and a measurement that makes the result plain.
There are only two pools of money large enough to sustain coordinated preventive care — Pharma and the health plans. WIN gives the plans a reason to act, in their own terms of MLR and PMPM: buying prevention costs less than buying discounted procedures.
01 · The Study
Prove both points and the case is made.
Primary endpoint
The share of enrolled patients who reach their blood-pressure goal, against a comparison group — anchored to the emerging HEDIS-style measure: 80% of patients below systolic 130, 80% of the time.
Secondary endpoint
Reaching goal faster than conventional therapy — even where WIN's approach takes more hands. Get people there, and keep them there.
Because WIN is not randomized, the comparison has to be a propensity-matched group of patients at the same four health systems, matched on as many clinical variables as possible. FHG builds it from data already collected across all four: take the roughly 5,000 WIN-enrolled patients (de-identified), find 7,500–10,000 matched patients, and compare per system, per physician, per clinic, or across the whole program.
02 · The Measurement
Transparent in its calculation. No black boxes.
The endpoints show whether the model works. The measurement shows why — and it is the part AHW does not have on its own. It begins with one idea: the presence or absence of a working clinical network, measured as the collapse of access.
The two markers
ED visits and hospitalizations. When they rise, access is thinning.
The prevention-credit lens
Does a patient come through the door and ever reach preventive care — or only reactive care? Give every bit of prevention full credit.
The tether score
Count the touches and the hand-offs. A one-time visit, or a real attempt at ongoing coordinated care?
The Coordinated Care Number
A clear index — across and within systems — of how well a patient got into coordinated care. Built from clinical data, claims, and the EHR record.
The measures divide into what improved (outcomes) and what produced it (drivers). FHG works between the health systems and the plans so both read the same numbers. The economics translate through MLR and PMPM — the plans' own terms.
03 · WIN Rural
Reaching every county is AHW's mandate — and the rural counties are where WIN matters most.
In most rural communities the hospital is the largest employer, and most of its revenue is Medicaid. Cut it and the decline is quick — the clinic goes, then the storefronts, and the county becomes a care desert. More than half of Wisconsin's counties are already a 50-to-75-mile drive from an OB. The rural-transformation money on offer is a fraction of what is being taken out. And rural facilities chase the same high-margin procedure revenue as everyone else — the robotic-surgery billboard on the county highway.
The health plan · cost ↓ access ↑
A plan like Molina wants to grow into the county. Steer the members who need coordinated care toward prevention, and the avoidable ED and hospital use that drives spend comes down — a lower PMPM on a population that is otherwise scattered and unmanaged.
The rural hospital · base + a layer
Nothing it bills today changes. On top of fee-for-service, a prospective per-member payment brings steady cash — enough to fund a nurse and the programs the community needs, so the hospital can be the anchor instead of chasing procedures.
The same three-payment model applies cleanly to the rural county. Nothing is taken away — a layer is added.
The visit
Fee-for-service, unchanged. The claims keep flowing exactly as they do today.
The stay
The hospital episode, paid the way it always has been.
The person
A prospective, risk-adjusted payment for the whole person, plus a share of the savings as avoidable use falls. This is the payment that lets the rural hospital be the anchor.
Seed · the county
plan lives in the county — a couple of primary-care panels.
Steer · the cohort
who need coordinated care — the cardiovascular and hypertension group WIN measures from day one.
Care reaches patients where they already are: monitoring runs through the smartphone, a quarterly truck brings labs to the driveway, a community health worker visits the house. The monitoring and medication adjustment can be handled from anywhere. The model already exists — the Detroit street clinics that took company trucks into the neighborhoods for hypertension and chronic kidney disease. Start with hypertension, then add cholesterol, weight, and diabetes — all remote. And once the data shows what a willing community health center does next to its neighbors, the FQHCs sign up.
Placeholders, to be priced off the plan's own claims. A modest per-member monthly payment on a much larger existing spend funds the anchor role — and avoids the long ambulance trips, the med-flights, and the observation stays that cost far more.
04 · The AHW Path
How AHW's own rules make the expansion fast.
Cardiovascular disease is already one of AHW's three pillars. So a rural expansion of WIN uses a lane AHW already has.
So the move is to keep WIN Rural inside the cardiovascular work AHW already funds. Make it about AHW — reaching all 72 counties, in the spirit of the endowment's founding mandate — with the health plans, not a monthly AHW check, paying for it. Build the interest now, so the counties that want in are ready when the door opens.
05 · What's Next
Small, concrete, and owned.
This sets out, for AHW's interim leadership, what WIN has proven and where it can go — the value the model shows, and the counties it can still reach.
About Forward Health Group
Forward Health Group has spent two decades making populations legible — turning claims and clinical records into a working picture of who needs what, and showing what changed. For WIN, that is the comparison group and the measurement: the evidence AHW and the health plans can hold.